“Whether you call them millennials or digital natives, there’s no denying that a generation of Americans, one that grew up along with their devices, is perceived to be more tech savvy than any that preceded it”

“Because of that technology and an unending roster of apps—from Snapchat to Stitcher and everything in between—today’s physicians in training seem to be more proficient in communicating and obtaining information. How does that translate to medical school or residency? When it comes to EHR training, one expert believes, it doesn’t”

“AMA Wire® spoke with Blaine Y. Takesue, MD, a research scientist at the Regenstrief Institute and assistant professor of clinical medicine at Indiana University School of Medicine. Dr. Takesue offered three reasons digital natives may still be in foreign territory when it comes to learning the ins and outs of EHRs.

EHR data doesn’t effectively translate to devices

While smart devices have in many ways replaced clunky computers in a number of arenas, that is less the case in the EHR realm. The smaller screen is a hindrance when it comes to reading and entering data, Dr. Takesue said.“If you’re used to a mobile solution to problems, that’s a much different paradigm than sitting at a computer,” Dr. Takesue said. “It has a lot to do with real estate. EHRs haven’t translated well to a phone. You need to see a lot of data. There’s not enough real estate on a phone to do that without moving through multiple screens.””

The EHR systems with which large health care organization’s work were created decades ago, and because of that, they don’t feature the same user functionality as newer devices.

“The problem is that many of the most widely used EHRs were not created from 2000 on—they were created last century,” Dr. Takesue said. “What we use in medicine and what we train our students on is legacy technology. There may be a solution that translates really well to mobile, which will allow questions to be answered quickly, but it’s not in wide use.””

Your smartphone, search engine or voice-activated device seems at times to know what you’re going to say before you do. Products that function this way—when the server anticipates potential communications—use a form of artificial intelligence to push out answers and solutions. EHR systems work the opposite way.

“We call it a content pull,” Dr. Takesue said. “As a user, you have to go and pull content you want to see when you want to see it.

For device users, “it hurts expectations,” he added. EHRs “don’t provide the information to the user at the time that they need that information.”

The hype on health apps. Here’s an overview of systematic reviews of trials on their impact. You’ll be astonished to hear there are very few trials, and gazillions of apps making health claims.https://t.co/yPbAy10leP

It’s all given me an idea to compile a list of the best examples of “Digital Quackery”. I’ll kick off the list with a few I’ve seen and please feel encourage to add your favorites in the comments (with the reasons):

CNBC have it captured well: A MAN IN WHITE COAT WITH A STETHOSCOPE TAPPING AT HIS MOBILE is a perfectly valid and useful depiction of telemedicine today. But watch a Patient using their own ECG machine and having their medical data read by a computer and referred if necessary to a Doctor (who may be casually dressed working from home while her children are at school) and you’ll realise just as video killed the radio star the incredible sensors in the super computers in our pockets have removed the tele (meaning is ‘distant’) and we now have to understand that healthcare is becoming a mobile experience (this is why it’s wiser to use the ‘mHealth’ term I coined 10+ years ago) because the potential for medicine/care is now always with us, continuously carried within arms reach and never turned off.

At the end of watching that video ask yourself do these Patients look like they are ‘distant’ from their medicine/care?

We have elderly Patients using these mHealth devices for years and when you ask them about their experience they’ve never felt closer to their medicine/care. There is no doubt that the convergence of healthcare to mobile (mHealth) has enabled us to evolve from TeleMedicine/Telecare.

“Telemedicine, or apps that let you consult with a doctor via video, was supposed to be the next big thing in health care But lack of awareness, questions about cost and reimbursement, and the human desire to talk to another person when sick have hampered the sector. Tech giants like Apple may ride to the rescue… Billions of investment dollars have been poured into apps and websites that offer this virtual consultations with physicians, ranging from Doctor on Demand to American Well. The theory behind them is that millennials would opt for a digital alternative to an in-person physician’s visit, if the option were available. And patients in remote, rural areas who are miles away from the nearest doctor would have few alternatives… …But telemedicine is still far from mainstream. Even a study sponsored by a telemedicine provider from late 2017 still found that 82 percent of U.S. consumers do not use it”

People may be gullible when it comes to sharing their data in exchange for online services (just look at the level of personal health info sharing that Patients provide to advertising networks like Facebook or Google) but most of the more experienced older people (who have healthcare needs or care for children or elderly Parents with them) realise there is value in sharing info with a Doctor who isn’t in the business of trading their personal health data.

Yes you can obviously bluff some naive people with the offer of cheap or free chats with a Doctor advice call but communities dominate brands and Patients/Carers are increasingly becoming aware that it’s not smart to subsidise/exchange your incredibly personal and revealing information with unnamed corporations for the advice of a Doctor.

“Why the lack of adoption? Several factors are to blame. The biggest, and most important, is that many U.S. consumers are still not aware they have the option to chat with their doctor over the phone or via video”

“The awareness piece is a big problem,” admits Ian Tong, a physician and the chief medical officer at Doctor On Demand, an app that offers smartphone consultations for $75. Tong believes that part of the problem is the branding of the term “telemedicine,” which isn’t particularly descriptive, so he’s opting to use the term “video visits” instead when he talks to patients about it”

I think this is a mistake and is not realising the additional value that can be offered now that +100 million Americans can connect via video calls on devices that they always carry with them.

“Another setback: Patients heard of telemedicine apps often fear the expense, especially if it’s unclear whether they can use their health insurance. And in some cases, the apps are offering cash prices that are out of reach. $75 might be a stretch for some”

“Another common theme is that the doctors who are willing to work with app makers are inexperienced, or low-quality. Companies like Doctor on Demand will say they go out of their way to vet — and pay for — the best clinicians. But there is some merit to this concern, especially with the lower-quality services”

“In 2016, researchers posing as patients turned to 16 different telemedicine apps to diagnose skin issues. The results? Some of the online doctors misdiagnosed conditions like syphilis, others prescribed unnecessary meds, and two of the sites used doctors who aren’t licensed to practice in the state the patient was located. The authors concluded that these apps repeatedly missed diagnoses by failing to ask simple, relevant questions”

but I think the websites tested were quite scammy eg. they published “a variety of disclaimers that they do “not provide health care services,” and do “not create a physician-patient relationship,” but we found that they did make diagnoses and offer specific treatment recommendations (without sending prescriptions to pharmacies)“.

I can’t see how Dr Resneck hasn’t been obliged to report the Doctors involved to their credentialing authorities before/at same time as publishing a public paper about how they are working dangerously and without licensure.

“Finally, even in the digital age, a lot of people simply want to see their doctor in person. They’re not Luddites. But sick, vulnerable people often need in-person reassurance from another human being in the room. A smartphone app simply won’t cut it”

“Will this ever change? Roy Schoenberg, the CEO of American Well, believes that doctors, insurers and employers will increasingly inform their patients about the option to use telemedicine, which will help consumers get over many of their fears. If they’ve already got a relationship with that doctor, a virtual consult might seem like an easier alternative to getting across town to a doctor’s office and sitting in a waiting room”

I think this is a very good measure of how wedded the USA healthcare system is to serving health insurers. Amercian Well has taken $210million in venture funding over 6 rounds yet still hasn’t realised the big opportunity is in offering services direct to Patients. Imagine the CEO’s at Uber/AirBnB/Spotify thought that the Taxis/Hotels/MusicLabels would inform their customers about the option to use their mobiles to get their product via their mobile phones!

“But getting doctors to jump on board is easier said than done, and takes time. Many are afraid of liability, as it’s possible to miss something during a remote visit. And for years, it wasn’t clear whether they would get paid as much as an in-person visit. Reimbursement questions are still getting resolved across different states, but most of the commercial and government plans are on board with the idea of telemedicine — at least in specific circumstances.Another marketing boost for telemedicine could come from the big tech companies. American Well got its a plug from Apple, which announced it would work with the company for its heart-health study, so that participants could get easy access to a doctor’s office if they needed it.”

“Finally, many consumers who use high-quality telemedicine apps are spreading the word. “Consumers are realizing that it can all be done via an app, whether it’s getting a prescription, an exam or ordering labs,” said Doctor On Demand’s Tong. “There’s no need to sit in that waiting room anymore.””

Some interesting feedback via Twitter chat with Irish GP Valerie Morris MD who has now for some unknown reason deleted her tweets which is a great shame as I was going to enjoy hearing Dr Morris explain how a ‘fully computerised’ GP doesn’t yet have a website nor offer Patients any access to Healthcare Records:

@DrVBMK: Quick comment: Busy surgery all day – 2 emergencies this morning – child & adult – managed here then sent the ED. And I’m only halfway through my morning list. of patients. Lunchtime is for home visit to see palliative patient. How on earth do you provide care using telemedicine

@mHealthInsight: I think you’ve presumed that I think the benefits of telemedicine is an excuse for under resourcing GP services.

@mHealthInsight: I think you’ve presumed that I think the benefits of telemedicine is an excuse for under resourcing GP services.

@DrVBMK: Are you a GP? Your tweets don’t reflect that you are one nor does it reflect real life General Practice.

@mHealthInsight: would you like a job?

@DrVBMK: Medical indemnity for full time Irish GPs is no less than €20,000 per annum (more if you provide telemedicine, OOH, minor surgery etc). Will you pay that upfront???

@mHealthInsight: How big is your HSE list as if 500+ it’s well worth us meeting up as I’m sure I could save you a small fortune

@mHealthInsight: Probably best to email me as documented video consults with Patients that aren’t enticed with offers of prescription drugs is very low risk

@DrVBMK: 98% of GP practices are fully computerised. The only time I use a pen is to sign my name. I am from the old School of Medicine. A computer will never be the interface between me and my patient. I respectfully decline your offer. I love my job.

@mHealthInsight: Do you really think there is a single “fully computerised” GP practice in the whole of Ireland?

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At the Apple World Wide Developer Conference (WWDC) today Apple announced that the latest iOS12 software update for the iPhone, iPad and Mac (expected to be live later this year) will support FaceTime group video calls with the ability to coordinate video calls with up to 32 participants supported by messaging features during the calls. FaceTime call participants can be added at beginning or mid-conversation and can select to join via video or audio only.

Imagine how powerful this will make FaceTime calls for Healthcare uses? Imagine how much more efficiently 911/999 Emergency FaceTime Calls would be? Imagine how amazing it would be for GPs to be able to dial up other Carers, Family Members and Specialists when they need assistance during a Consultation? Imagine how much more effectively Video Consulting services are going to be able to perform?

What uses and new services can you think of for this new mobile video calling service?

The global pharmaceutical industry has seen a downturn in recent years because of the challenges and cost associated with pharmaceutical development, procrastination in drug development, etc. Clinical trials field is also faced with such challenges. Cases of failures, cost and delay are high. It is high time that we look into innovative strategies, new technologies, effective and quality collaborations to address these issues, which can cater to the needs of the patient and the industry. Due to complex clinical trials and bygone data standardization methods, we need algorithms and lucrative strategies that will enhance the clinical trials outcomes. There are vast data collected across clinical trial process, the standardization of these data will turn into an opportunity for companies to trap the information and raise clinical trial design, patient recruitment, monitoring insights and augment decision-making”

Get in touch via the comments if you’ll be in London and would like to meet up. Refresh this page on Friday April 27th 2018 for my slides and a video of the talk. In the meantime you might like to watch a presentation I gave a couple of years ago on the topic of “What would happen if we took a Mobile First approach when designing Clinical Trials”:

It’s horrific to see new private only pay clinics springing up in areas of the UK where poverty is the highest and it’s because immigration offenders have realised that the supposedly ‘confidential’ NHS GP and Hospital records relating to them and their families are being used to shop them to the Home Office.

Of course there are a million other more effective ways to trace immigrants (they are mostly young and have mobile phones that are accurately identifiable by location or they are being homed/employed by citizens who have mobiles and all of this monitoring can be easily done by the Home Office) so I think it’s clear the NHS is doing this because it thinks they’ve concluded that there is a short term economic benefit.

It should be clear that it is vastly cheaper to give every immigration offender free NHS care than it is to try and care for them when they get really sick and turn up with a false identity in a hospital. By sharing details (that include Patients’ names, date of birth, address) the NHS is driving growth in criminal gangs who are stealing citizens identities and this is putting Patients (and the Professionals trying to care for them) at much greater risk of making very expensive mistakes (treating a Patient based on completely inaccurate information in their NHS Record).

No individual Doctor is going to speak out, refuse or complain against the Home Office because they will probably just turn their investigation to the ‘non-compliant’ Doctor so please support the British Medical Association and Royal College of GPs call for a suspension of a memorandum between the Home Office and NHS which has given them access to data that is undermining the ethical principles underpinning confidentiality and the determination to act in the best interests of Patients.

“The AMA is working to unleash a new era of patient care through its Integrated Health Model Initiative (IHMI) by pioneering a common data model for organizing and sharing meaningful health data like patient goal, state and functioning, and assembling an unprecedented collaborative effort across health care and technology stakeholders” said AMA President David O. Barbe, M.D., M.H.A.”

“The winning ideas will demonstrate how the applicant uses patient-generated health data in meaningful ways to have maximum impact on improving physician workflow, improving clinical outcomes, and reducing cost in the health care system. The three best ideas that are submitted to the Challenge by June 7, 2018 will be selected to share $50,000 in credits for Google Cloud”

What a bizarre set of zero-actual-cost prizes. Google is highly profitable and is generating over $100,000,000,000 in annual revenues so why are the prizes being given to promising start ups being paid in ‘monopoly’ money?

I have no doubt the AMA shopped this collaboration opportunity around with Apple, Facebook, Microsoft and Amazon and in deciding to work with Google they didn’t agree to be paid for the collaboration with Google Cloud Credits (I doubt most of the executives at the AMA even know what they are).

CHICAGO – The American Medical Association (AMA) today announced the AMA Health Care Interoperability and Innovation Challenge sponsored by Google to inspire novel examples of mobile health technology—such as wearable devices and applications—that effectively monitor and share medical data between patients and physicians to improve the management of chronic diseases.

“The AMA is working to unleash a new era of patient care through its Integrated Health Model Initiative (IHMI) by pioneering a common data model for organizing and sharing meaningful health data like patient goal, state and functioning, and assembling an unprecedented collaborative effort across health care and technology stakeholders” said AMA President David O. Barbe, M.D., M.H.A. “The Challenge we’re announcing today is an extension of the AMA’s work and will explore possible uses of mobile health technology to provide patients and physicians with a rich stream of medical data that is important for improving care and long-term wellness.”

The Challenge invites the health and technology sectors to present solutions that demonstrate how patient-generated data is captured by mobile health monitoring technology, transferred to a medical practice, and transformed into accessible and actionable information for the patient and physician to improve health outcomes.

Specifically, entrants are asked to present ideas on how to:

Import (or transfer) patient-generated health data from a mobile device or a mobile application into one or more phases of clinical care. Examples of phases: Assessment of current condition, risk stratification, goal definition (both patient and physician), treatment plan, intervention(s), recording of observed outcomes, re-assessment.

Extract (or transfer) data from one or more phases of the clinical care and send it back into a mobile application or mobile device so patients can view, track and ultimately act upon the information relative to their goals or share it with other physicians.

The winning ideas will demonstrate how the applicant uses patient-generated health data in meaningful ways to have maximum impact on improving physician workflow, improving clinical outcomes, and reducing cost in the health care system. The three best ideas that are submitted to the Challenge by June 7, 2018 will be selected to share $50,000 in credits for Google Cloud.

About the American Medical Association The American Medical Association is the premier national organization providing timely, essential resources to empower physicians, residents and medical students to succeed at every phase of their medical lives. Physicians have entrusted the AMA to advance the art and science of medicine and the betterment of public health on behalf of patients for more than 170 years. For more information, visit ama-assn.org.

AMA Challenge Salutes Three Mobile Health Innovations

For immediate release:

Jun 29, 2018

CAMBRIDGE, Mass. – Cutting edge examples of new mobile health monitoring technology were recognized today as the American Medical Association (AMA) announced the top three solutions submitted to AMA Health Care Interoperability and Innovation Challenge sponsored by Google Cloud.

The challenge is an outgrowth of the AMA’s Integrated Health Model Initiative(IHMI), an unprecedented collaborative effort to unleash a new era of patient care by pioneering a common data model for organizing and sharing meaningful health data. The challenge underscores the AMA’s commitment to bridging the gap between creative idea development and enhanced patient care, and creating a deeper understanding of how mobile health technology can capture, share and transform data into accessible and actionable information for the patient and physician to improve health outcomes.

“The AMA issued the challenge to inspire the creation of novel mobile technology that demonstrates innovative uses of health data to support the long term wellness of patients,” said AMA Chief Medical Information Officer Michael Hodgkins, M.D. “The top solutions chosen in the AMA Challenge have the potential to be transformational innovations that effectively share meaningful medical data between patients and physicians and create a healthier nation.”

Health and technology entrepreneurs from around the world submitted 36 solutions to showcase technology that uses patient-generated health data in meaningful ways to have maximum impact on improving clinical outcomes, streamlining physician workflows, and reducing costs in the health care system. Eight semi-finalists were selected from the submissions and asked to pitch their ideas in front of a live audience and panel of judges at the Google Campus in Cambridge, Massachusetts.

The three winning solutions selected from among the semi-finalists share $50,000 in Google Cloud credits to accelerate their solutions.

This software company based in Gainesville, Fla. offers a mobile health platform that focuses on the necessary delivery of information between patient and provider to improve health outcomes. HealthSteps connects people around the concept of a digital care plan. Through their own mobile devices, patients can be more engaged with their care plan activities and share their care plan with family and other caregivers. HealthSteps works to gain real-time data which sets it apart.

I-deal Health, based in Tel Aviv, Israel, empowers patients to visualize their personal risk for multiple diseases, choose goals to reduce their risk, and close the loop between patients and clinicians to seamlessly achieve success. I-deal Health works to connect patient and provider through the use of health data in a manner that supports both parties. Through individualized treatment derived from EHR data, patients can work to focus their efforts through the help of the I-deal Health mobile application.

Based in Omaha, Neb., the goal of FUTUREASSURE LLC is automation of surgical intuition by using validated data to implement mobile technology into standard clinical workflow; thus assuring medical decision-making. This agnostic system can collect clinical and research data for the assessment of patient risk for surgery. It works to provide objective data that can predict surgical outcomes previously not compared.

“The future of health care is literally in the palm of our hands,” said Benjamin King, CEO of HealthSteps. “Mobile technology has created a pathway for a new dynamic in the physician-patient relationship, and HealthSteps is leading the way.”

The three winning ideas were deemed by judges to best demonstrate uses of patient-generated health data to have maximum impact on improving physician workflow, improving clinical outcomes, and reducing cost in the health care system. All qualified entries will receive an entry prize of $3,000 in Google Cloud credits.

About the AMA
The American Medical Association is the powerful ally and unifying voice for America’s physicians, the patients they serve, and the promise of a healthier nation. The AMA attacks the dysfunction in health care by removing obstacles and burdens that interfere with patient care. It reimagines medical education, training, and lifelong learning for the digital age to help physicians grow at every stage of their careers, and it improves the health of the nation by confronting the increasing chronic disease burden. For more information, visit ama-assn.org.